A
new American Cancer Society report outlines 21 challenges and needs for
global tobaccocontrol, covering the wide range of issues to be
addressed and expertise needed to reduce the rising tide of tobacco use
worldwide, particularly in the low- and middle-income nations that are
the target of the multinational tobacco industry.

The
report's authors, led by Thomas Glynn, PhD, American Cancer Society
director of Cancer Science and Trends, point out that the globalization
of tobacco began with the European exploration of the New World more
than 500 years ago. But it is only in the past 50 years that public
health has responded to the death, disease, and economic disruption
caused by tobacco use. Tobacco now has at least 1.3 billion users and
kills more than 14,500 people every day, while debilitating and
sickening many times that number. The report lists activities,
policies, and interventions that must be increased or in some cases
decreased in order to be successful in reducing the rising tide of
tobacco use.

Increase
challenges

Increase
support for and adherence to the Framework Convention on Tobacco
Control (FCTC): The report calls this the single most important action
in the effort to eliminate tobacco-related death and disease, saying
all governments should be encouraged to join the more than 165 nations
who already have ratified the treaty, and that those who have joined
the Framework should faithfully implement it.

Increase
access to comprehensive treatment for tobacco dependence: With more
than 1.3 billion tobacco users in the world today, if only half of them
wished to stop their tobacco use, there would be need for access to
tobacco dependence treatment for greater than 650 million tobacco
users. Furthermore, the World Bank has estimated that more than 180
million lives could be saved in just the first half of this century if
the prevalence of current tobacco users were cut in half by 2020, and
providing access to adequate treatment would be a cornerstone of that
approach.

Increase
media-based tobacco counter-marketing campaigns: Although the tobacco
industry will always far outspend tobacco control advocates, novel,
entertaining, cutting-edge tobacco counter-marketing campaigns have
been shown to attract attention and support far beyond the amount of
funds spent and to have a direct effect on reducing tobacco use.

Increase
regulation of all tobacco products: Tobacco is the most unregulated
consumer product on the market today, exempt from important basic
consumer protections, such as ingredient disclosure, product testing,
accurate labeling, and restrictions on marketing to children.

Increase
health warnings on tobacco packaging: As warnings become more graphic,
tobacco users are more likely to pay attention to them.

Increase
availability of tobacco health/economic information to the general
public: Many tobacco users, policymakers, and even health care
professionals are largely unaware, or only vaguely aware, of the other
cancers, heart disease, lung disease, pre- and postnatal conditions,
etc that are caused by tobacco use.

Increase
primacy of health over commerce in trade agreements: Successful
arguments have been made that excluding tobacco from trade agreements
is compatible with international law, which provides for other harmful
products such as landmines to be exempted. In addition, the World Trade
Organization (WTO) has declared that human health is an important
consideration and that if necessary, governments may "put aside WTO
commitments" to protect human life.

Increase
basic biomedical and applied tobacco control research

Increase
the extent and accuracy of tobacco epidemiologic and surveillance data

Increase
litigation aimed at the tobacco industry

Decrease
challenges

Decrease
tobacco use by physicians and other health care providers: Many
physicians and health care providers continue to use tobacco, with use
reported to be as high as 50% or more in some countries

Decrease
targeting of women: The WHO has estimated that the prevalence of
smoking among women worldwide will be 20% by 2025, compared with the
12% of the world's women who currently smoke.

Decrease
exposure to secondhand smoke: Providing smoke-free environments has
been proven to not only protect nonsmokers, but also encourage smokers
to quit and focus greater attention on the need for tobacco control
measures.

Decrease
illicit trade and smuggling

Decrease
duty-free and reduced-cost sales of tobacco

Decrease
tobacco advertising, promotion, and sponsorship

Decrease
misleading tobacco product claims/descriptors

Decrease
targeting of youth

Decrease
subsidies for tobacco production

Decrease
youth access to tobacco

The
report says there are certainly many other challenges not discussed in
the report and that,while "resources … will never be enough
to address all of these challenges," actions taken with the resources
currently available will have a significant effect on global health.
Finally, the report points to an issue it says rises above all others
when considering the potential to reverse the global tobacco epidemic:
the need for skilled, dedicated people to address the issues outlined
in the report.

For
more information on the American Cancer Society, visit www.cancer.org.